“What’s your political project?” Health equity research requires blending activism with research methods

NEW DELHI, DEC 3. A five-day workshop on “Cutting Edge Research on Health Inequities: Concepts and Methods” was organised by the Health Equity Action Lab (HEAL) of the George Institute for Global Health India in collaboration with the Health Equity Network India (HENI), and the Azim Premji University in Bengaluru last week.

The objective of the workshop was to sensitise mid and early career researchers to the concepts of health equity and how research in the area requires a completely different approach stressing on intersectionality and power analysis, questioning the status quo, challenging historical and social contexts that spur inequity, and being reflexive about one’s own positionality in doing work on health equity-- in short, blending activism with research.

The workshop began with a power walk on day 1 that sensitised the participants to the fact that when it comes to healthcare, the starting point is not the same for everyone. Further, there are groups which face multiple disadvantages at a societal level and that this affects healthcare access, utilisation and status. Health equity research therefore requires a special effort to map them and to find ways to integrate them in the present system.

This was followed by an exposition of the concept of intersectionality by Dr Devaki Nambiar, Head, Health Equity, Research, George Institute for Global Health India. Drawing on the origins of the concept in racial justice and women’s rights movements in the US, Devaki talked about the application of this lens in health research, its link to the power walk and its strengths and weaknesses.

Another session on concepts related to equity looked at the ideas of structural violence, marginalisation, embodiment and other core ideas in research on health equity. Denial of rights and discrimination is deeply rooted in the system and to ensure that the disadvantaged populations are included requires a systematic anlysis of who are getting left out, targeted methods to reach them and constant monitoring and evaluation to ensure that they do not fall prey to the machinations of power or exclusion that are unfortunately built into our system.

A session on day three was entitled “Who am I in Research?” seeking to get participants to reflect on their positions and epistemology in relation to research – to share their definitions of what research is and why they do it. This was followed by deep dives into quantitative, qualitative and mixed methods approaches to research with lots of examples and discussion with participants.

Over the course of the subsequent three days, the group discussed published and “live” case studies with steer from resource persons working on a range of issues. Published case studies included research into health status of urban low income populations, obstetric violence, caste and health-seeking, the use of religious shrines for mental health conditions, and migrant experiences of people living with HIV . “Live” case studies explored the professional and personal journeys of health equity researchers who also presented their work on tribal health and nutrition, the health-seeking of sexual minorities, gender gaps in health insurance, understanding structural causes of maternal deaths, and the linkage between human and ecological health using the lens of menstrual hygiene.

Through presentations and reflection on the case studies presented, the participants were challenged to widen their horizon and think using the health systems approach, identify enablers and facilitators and how an equity focus brings in other actors and players who are part of the system and who are either supporting those who are marginalised or standing in the way. Often these factors have a historic or social context and requires activism to bring in a new approach as was witnessed in some the case studies presented.

On the fourth day, the participants were asked to choose a topic in groups and make a plan on how they would incorporate elements of health equity into their research. This was an opportunity to put to test all they had learnt or unlearnt in the past four days. On the last date of the workshop, the participants –in self-titled groups named Bananas, KnowName, BAAPS and the Social Justice League - made presentations before the panel of resource persons who guided them by asking probing questions and honing their learnings in the process.

The rich panel of resource persons at the workshop included senior health equity researchers like Arima Mishra, Renu Khanna, N S Prashanth, Venkatesan Chakrapani, Vandana Prasad, Rajalakshmi, and Tanya Seshadri, who all helped co-design the course with Devaki Nambiar. A highlight of the workshop were the evening get-togethers under a tree, where participants would sing, dance, and come to know each other more deeply, a step closer to becoming fellow travellers on each other’s’ political projects. As Emma Goldman is (mis)quoted as saying “If I can’t dance, I don’t want to be part of your revolution!”

As the workshop ended, participants walked away with a new approach and focus to their work and wondering whether they will be able to build it into their research as often times funders are focussed on research outcomes and not challenging deep-rooted prejudices rooted in historical or cultural context. Nevertheless, each one of them sensed the beginning of a new journey, one that would require them to wear the hat of being an activist along with being a researcher and challenge the status quo.